Usability Testing of a Multi-Level Modeling Framework for Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health

The JITAI is an intervention design to support health behavior change. We designed a multi-level modeling framework for JITAIs and developed a proof-of-concept prototype (POC). This study aimed at investigating the usability of the POC by conducting two usability tests with students. We assessed the usability and the students' workload and success in completing tasks. In the second usability test, however, they faced difficulties in completing the tasks. We will work on hiding the complexity of the framework as well as improving the frontend and the instructions.

A Method for Generating Dashboard Aggregations in an International HIV Consortium

Online dashboards are valuable tools for gaining insights about population health metrics of interest and for disseminating data collected through research networks. The process of aggregating data from separate databases for use in online dashboards, while also ensuring data quality, is complex. We describe a method for integrating HIV dashboard aggregation scripts into an existing web-based data quality checking application and leveraging REDCap to store aggregated metrics.

Can Researchers Assess the Suitability of Datasets to Answer Their Research Questions, with Access to Metadata Only?

Health research increasingly requires effective ways to identify existing datasets and assess their suitability for research. We sought to test whether researchers could use an existing metadata catalogue to assess the suitability of datasets for addressing specified research questions. Five datasets were described in the National Institute for Health Research Health Informatics Collaborative metadata catalogue, and for each dataset five associated research questions were formulated, some of which were answerable with the dataset while others were not. Thirteen researchers each assessed whether the ten questions associated with two randomly selected datasets were answerable with the described datasets. After removing instances where participants misunderstood the question or lacked subject matter knowledge to make the assessment, we found that 87 out of 109 assessments (80%) were correct. Participants particularly struggled with one dataset which consisted of EHR data. The most common reason for incorrect assessments was the inability to find the relevant information in the metadata catalogue.

Towards Adaptability of Just-in-Time Adaptive Interventions

Just-in-time adaptive interventions (JITAIs) can promote behavior change in patients. It was the aim of our study to make JITAIs adaptable, i.e., to configure JITAIs for different purposes and to personalize them for different participants, whilst enabling central maintenance and integrated data analysis across deployments and individuals. We present a concept for adaptable JITAIs that was created following a design science approach. It builds on multi-level conceptual modeling and knowledge graphs and will be evaluated in user studies.

Generating and Knowledge Framework: Design and Open Specification

Introduction:

The Information Aggregation (IA) component manages streaming and batch data deriving from a multitude sources in a scalable, efficient and reliable way to create Holistic Health Records (HHRs).Within this context, the IA component combines a number of diverse data sources into a common format and stores information in an available form to be used for analytics, simulations and decision making.

Aim:

The purpose of this paper is to provide an overview of the CrowdHEALTH project and the technical architecture of the CrowdHEALTH platform in order to put the aforementioned IA mechanism in context. This is followed by the design details and initial specifications of the first prototype of the IA component as well as its relationship with other components.

Methods:

The micro-service approach can be used to perform information aggregation and to update HHRs in the CrowdHEALTH platform. Micro-services are a variant of the service-oriented architecture (SOA) where applications are structured as a collection of loosely coupled services with defined interfaces.

Results:

Within the CrowdHEALTH architecture, the Information Aggregation component is situated between the Interoperability Layer and the CrowdHEALTH Datastore. The Information Aggregation component processes and aggregates interoperable data, before data aggregation in the HHRs and storage in the big datastore of CrowdHEALTH platform. The aggregation functions use big data management techniques and enhance the state of the art in specific areas such as the use of micro-services to perform synchronous aggregation operations on heterogeneous datasets.

Conclusions:

Although an initial version of the IA component was presented, the specifications and implementation level details will be further updated during the project’s course.

Development of Patient State Model to Overview Clinical Registry Database

By applying the Bayesian network method to the clinical registry database J-DREAMS (Japan Diabetes compREhensive database project based on an Advanced electronic Medical record System), we have developed a reference model that summarizes the exploration of the patient group's state and facilitates a bird's-eye view. This visualization method would help registry researchers to screen the registry database.

Are mortality projections always more pessimistic when disaggregated by cause of death?

"It is often observed that mortality projections are more pessimistic when disaggregated by cause of death. This article explores the generality and strength of this relationship under a variety of forecasting models. First, a simple measure of the pessimism inherent in cause-based mortality forecasts is derived. Second, it is shown that the pessimism of cause-based forecasts can be approximated using only data on the distribution of deaths by cause in two pervious time periods. Third, using Japanese mortality data during 1951-1990, the analysis demonstrates that the pessimism of cause-based forecasts can be attributed mainly to observed trends in mortality due to cancer and heart disease, with smaller contribution due to trends in stroke (women only), pneumonia/bronchitis, accidents, and suicide. The last point requires the important qualification, however, that observed trends in cancer and heart disease may be severely biased due to changes in diagnostic practice." (SUMMARY IN FRE)

Sex differences in measles mortality: a world review

BACKGROUND

In general females have a lower mortality than males at all ages. Excess female mortality has been documented in certain high mortality situations, in particular in South Asia. However, females may have a higher mortality for certain causes of death. One of the causes of death for which excess female mortality is suspected is measles.

METHOD

Sex differences in measles mortality are investigated using all national data on causes of death published by WHO since 1950. An index of excess mortality is used: the geometric mean of the female sex ratios of age-specific deaths rates from measles, from age 0 to 44 years.

RESULTS AND CONCLUSIONS

When pooled together, the results show an excess of female mortality from birth until age 50 years. The excess female mortality appears small at age 0-4 (+4.2%), larger at age 5-14 (+10.9%) and peaks during the female reproductive period, at age 15-44 (+42.6%). This pattern of excess female mortality occurs in all the major regions of the world: Europe, North and South America, Far-East Asia, the Middle East and South Asia. The only noticeable exceptions are the Philippines and Thailand. The validity of the finding is extensively reviewed. Emphasis lies on the statistical power to prove that sex differences in measles mortality do exist, on the critical analysis of a case study in England and Wales, on the comparison with the overall pattern of sex differences and on available data on sex differences in incidence. Possible explanations are reviewed.

Assessment of maternal mortality in Tanzania

OBJECTIVE

To assess maternal mortality.

DESIGN

Prospective community-based survey, a sisterhood method survey and hospital data.

SETTING

The study was performed in communities in a rural area in Northwestern Tanzania and the local district hospital.

RESULTS

Four hundred and forty-seven pregnant women in the community survey were followed up as far as six weeks after delivery; there were 2865 respondents in the sisterhood survey; the hospital study involved 7526 deliveries. Maternal morality ratios derived from the prospective community-based survey, the sisterhood method survey and hospital data analysis were 241, 297, and 845 per 100,000 live births, respectively.

CONCLUSIONS

Hospital data tend to overestimate maternal mortality in these communities. The sisterhood method is easier and more convenient than a prospective community-based study.

Providing antenatal services in a primary health care system

A study sample of 880 women attending the primary health care center in the Al-Baha region of Saudi Arabia was interviewed on their attitudes towards antenatal care services in the primary care setting. Some 91.3% of the women expressed positive views about obtaining the antenatal care in these centers. The major factor influencing their choice was the geographic location of primary health centers which are near to their residence and therefore more convenient for them to patronize. Other factors were the easier access to staff in primary care centers, especially mid-wives and female doctors. There was a significant relationship of age, parity and education with their current antenatal and delivery practices. The women also recommended less than ten antenatal visits before delivery. These findings are relevant to any policy regarding maternity services in the country.

Comparison of mortality between villages with and without Primary Health Care workers in Upper River Division, The Gambia

Health services utilization was analysed in a rural area of the The Gambia. In general, health workers were consulted frequently. However, verbal autopsies showed that children who died had rarely consulted health workers, particularly if they came from villages where such workers were not posted. Traditional healers were consulted frequently, independently of the presence of a village health worker. The relationship between cause specific mortality and the utilization of health services is discussed. Childhood mortality was similar in villages with or without a primary health care worker at the time of the study.

The use of traditional methods of contraception among Turkish couples

About half the users of contraceptives in Turkey employ traditional methods of family planning, particularly withdrawal. This report presents data from a 1988 national survey to examine Turkish couples' use of and opinions about these methods. Use of traditional methods is widespread across all geographic, demographic, and socioeconomic groups. The principal reasons reported for not using methods generally considered to be highly reliable were fear of health problems and side effects and the opposition of husbands to such methods. Most couples who practice withdrawal also feel that it is as effective as modern methods. These findings imply that a major focus of family planning efforts should be the education of women, of their partners, and of health-care and family planning providers concerning the benefits, risks, and failure rates of both traditional and modern contraceptive methods.

Attitudes of males to contraception in a Kenyan rural population

The results of a contraceptive attitudes survey on 355 men carried out between January and March 1987 in Machakos District of Kenya are presented. 93.2% indicated that they approved of Family Planning. Although 63.9% of the respondents felt that family size decision making should be a couple's responsibility and 78.6% of respondents preferred a husband and wife approach to family planning counselling, 56.9% said that the women should be the one to actually use the contraceptive. 88.7% approved of female sterilization while 64.5% disapproved of vasectomy. There is need to re-evaluate the current integrated maternal child health-family planning services to actively and effectively accommodate men.

Contraceptives, counselling, and pregnancy in women with sickle cell disease

Sickle cell disease is listed in the manufacturers' data sheets in the United Kingdom as a contraindication to the use of most combined contraceptive pills; the result is confused advice on family planning to a group of women who are at substantial risk from both planned and unplanned pregnancy. A study in north London on the use of contraceptives by women with sickle cell disease indicates that the use of combined oral contraceptives is common. Although medical staff usually advised against pregnancy, such advice was almost always ignored. Over half of the women surveyed had some knowledge about antenatal diagnosis. Family planning advice should be an integral part of the care of women with sickle cell disease. In the absence of specific data to the contrary all methods of contraception may be considered, although with appropriate caution.

Perinatal mortality in a northern Nigerian rural community

87 perinatal deaths which occurred out of 1484 births in a rural area of Northern Nigeria over a 9 month period were reviewed. The perinatal mortality rate was 58.6 per 1000 births. Babies born to very young adolescent mothers aged between 10-14 years had the highest perinatal mortality of 375 per 1000 births. Statistically significant relationships were also established between perinatal mortality and parity, educational status of the mother and birth weight. The leading cause of perinatal death was birth trauma which accounted for 48% of all perinatal deaths. Strategies for the reduction of perinatal mortality in the rural community are highlighted.

Vaccines in the national immunization programme

Papua New Guinea has been providing expanded immunization services for more than 14 years. While immunization coverage has risen dramatically, recent surveys have raised serious questions regarding vaccine potency at the service delivery level. Operational practices in vaccine distribution and in the delivery system have been identified in this paper. The international and national standards for vaccine management are described along with the main requirements for maintaining vaccine potency. Quality assurance measures, the responsible personnel and the appropriate intervention points are detailed, along with easily applied guidelines for implementation. An approach to assessing the effectiveness of the quality assurance measures is proposed.

How socioeconomic status affects birth and death rates in rural Kerala, India: results of a health study

Data relating to birth and death were collected from throughout the state of Kerala, India, in a health survey conducted by the Kerala Sastra Sahitya Parishad, a voluntary organization. In this study, the authors analyze birth and death rates as calculated from the sample of 9,940 households (57,665 persons), with respect to other variables such as region, religion, and socioeconomic status. In order to study the effect of socioeconomic factors on birth and death rates, a socioeconomic status rating (SES rating) was developed, taking into account such factors as income, education, housing conditions, and land ownership. Socioeconomic status was found to have a definite influence on birth and death rates, with higher socioeconomic status resulting in lower birth and death rates. This effect was independent of such confounding variables as age structure of the population, religion, and region. The higher risk of mortality among the poorer households can partly be explained by the material deprivation: the higher birth rates could be the result of poorer educational attainments.

The UPA score and teenage pregnancy

Teenage motherhood is often said to be the result of deficient contraceptive and abortion services. Using data from the Public Health Common Data Set (PH CDS) we demonstrate two important effects in a Regional Health Authority: higher rates of conception are related to a live birth rather than an abortion pregnancy outcome; District Health Authorities (DHAs) with high underprivileged area scores (UPA) are more likely to have high rates of conception in the teenage years than those districts with low scores.

A new approach to eliciting information about induced abortion

Reliable quantitative data on abortion are sorely needed, particularly in developing countries. Past experience in large-scale survey research has demonstrated that direct questioning on this subject results in significant underreporting. This article presents results of an experiment to collect data on induced abortion in Côte d'Ivoire within the context of a family planning operations research study. First, questions were employed to broach the topic of unwanted pregnancy in a value-free manner, and then the potential for a variety of actions, including abortion, was acknowledged. The results indicate that approximately 25 percent of all women attending a family planning clinic on the day of the survey had had an induced abortion. The use of improved abortion-related questions shows promise for providing more complete measurement of a neglected dimension of women's reproductive health.

Health beliefs and behaviors of Saudi women

This paper describes perceptions of familiarity with symptoms and beliefs about illnesses based on interviews with 50 Saudi women. The sample was young, with 82% under the age of 40, and not well educated by Western standards, with one-third being illiterate and 80% having no more than a primary school education. More than half lived in households of six or more. Although there was greater awareness of germs as causative factors in illness than previous studies in Saudi Arabia had demonstrated, beliefs in multiple causes, including religious beliefs about disease causation, persisted. There was an apparent lack of understanding of specific causes of various illnesses or of the rationale for preventive measures. This lack of understanding may be related to the low education levels and/or deeply ingrained cultural beliefs.

Measurement of child mortality in association with a multipurpose birth certificate programme in the Southern Highlands Province of Papua New Guinea

A simple and inexpensive method for monitoring child mortality in association with birth registration was introduced into the Southern Highlands of Papua New Guinea. Eight thousand two hundred and one newborn infants were registered in 1988, approximately 77% of all children born in that year. The risk of death by age 2 was determined from reports given by the mother on the present status of a previously born child at the time of a recent delivery or during clinic registration of the current birth. This was 91 per 1000 for the province and corresponds to a risk of death by age 1 of 77/1000 by extrapolation using standard lifetables. This method was validated by comparison with a continuing demographic surveillance system covering 30,000 people in the western part of the province. The new birth certificate has been an incentive to increase supervised delivery rates and to generate a register that can be used to increase vaccination coverage.

Child mortality in new industrial localities and opportunities for change: a survey in an Indian steel town

As Asia becomes increasingly urbanized the effect of new industrial development on child mortality becomes of increasing interest. In India, considerable investment has been made in the social infrastructure of industrial new towns. This survey of Durgapur steel town in West Bengal shows that although the average level of child mortality in the working class population is favourable in comparison with other Indian cities, considerable differentials, that can be related to social, economic and environmental differences within the population, have arisen since the creation of the city in the late 1950s. The paper argues that the undertaking of selective sanitary interventions to improve access to drinking water (in particular) would be administratively feasible in these industrial new towns, of immediate impact, and indeed necessary if the differentials in mortality are to be eliminated.

Cumulative pregnancy rates in patients with apparently normal fertility and fertility-focused intercourse

Fifty consecutive clients achieved pregnancy using a standardization modification of the Billings ovulation method (the Creighton Model Natural Family Planning System). Of 50 clients followed, 38 (76%) achieved pregnancy in the first cycle of fertility-focused intercourse, 45 of 50 (90%) achieved pregnancy by the third cycle and 49 of 50 achieved pregnancy by the sixth cycle (98%).

Consanguineous marriage in Jordan

We conducted a population-based study of consanguineous marriages in Jordan. About two thousand households were interviewed. First cousin marriages were encountered in 32.03%, second cousin in 6.8%, distant relation in 10.5%, and no relation in 50% of all marriages, respectively. Inbreeding coefficients were compared with those of other countries. The most important variables affecting inbreeding were social tradition, religion, education, and place of residence--urban vs. rural. Secular trends appear rather stable since the early decades of the twentieth century, especially for first cousin marriages. Jordan society showed a deeply rooted traditional behavioral pattern when inbreeding is considered.

Sexual abuse of children as seen at Kenyatta National Hospital

A retrospective study of 21 sexually abused children admitted to the Kenyatta National Hospital, Nairobi, Kenya, between January 1984 and December 1985 is presented. The peak incidence of sexual abuse was in the age group of 10-15 years (38.1%) followed by the 5-9 years age group (28.6%). Strangers and people familiar to the child were equally implicated as assailants. Fourteen out of the twenty one (66.7%) victims, presented with injuries ranging from perineal tears (19%), vaginal tears (19%), recto-vaginal fistulae (RVP) (4.8%) and vesico-vaginal-fistulae (VVF) and abdominal haematoma (4.8%). The victims presented to hospital within two days of the event usually accompanied by their mothers.

Season of birth: issues, approaches and findings for autism

Rates of birth in the general population show seasonal fluctuations for reasons that are ill understood. Variations from these general population patterns have been reported for several psychiatric conditions and used as the basis for aetiological hypotheses. In this paper, the evidence for alterations in the expected seasonal fluctuation in birth dates of autistic people is evaluated. A national sample of 1435 autistic individuals and a clinic sample of 196 subjects are compared to general population figures and to 121 sibling controls. Compared with the general population, the national sample showed significant deviations from the expected rate of birth by month. In the clinic sample, differences from the anticipated monthly pattern were only evident when this sample was compared to the sibling controls. A variety of models for seasonal trends, including year quarters, temperature and sine wave forms, were fitted to these variations but no consistent picture emerged.

Seasonality of births in nineteenth-century urban Tasmania

The monthly distribution of births for Hobart Town, Van Diemen's Land, during the period 1839-1859 is examined. Prior research on two rural registration districts in nineteenth-century Tasmania revealed patterns of birth seasonality. The pattern was responsive to both the distinctive seasonal rhythm of regional economic activities and the birth interval and differed from the pattern for all of Tasmania in the twentieth century. Here, I argue that the aggregate monthly pattern of births in a mid-nineteenth-century urban registration district was, by contrast, not seasonal. Some seasonality was found among farmers, seamen, and dealers in foodstuffs but not in other industry groups. Class differences were not apparent. The research establishes that the seasonal distribution of mid-nineteenth-century urban births corresponds neither to nineteenth-century rural patterns nor to the patterns evident in the twentieth century.

Family planning and induced abortion in the USSR: basic health and demographic characteristics

In 1988, the USSR Ministry of Public Health published official statistics on abortion for the first time in 60 years. Using the official data published in 1988 and unofficial statistics from a variety of independent sources, this report attempts to describe some of the basic features of fertility regulation in the USSR. Induced abortion is the main method of fertility regulation throughout the country, and a high proportion of induced abortions are unregistered and performed illegally. The availability and use of modern contraceptives is low; among those who practice contraception, traditional methods predominate. The official data leave much to be desired in the way of accuracy, reliability, and completeness. However, it is clear that the level of induced abortion is higher in the USSR than in any other country in the world.

A nonparametric approach to analyzing large human populations

There are many statistical techniques that require the assumption that the population being studied is normally distributed--regression analysis, multivariate analysis, time series analysis, and so on. Unfortunately, as the development of survey sampling has long acknowledged, large human populations are usually stratified into several different subpopulations. Since the boundaries between the strata are somewhat blurred, they are not independent, so the overall distribution of the population tends to be multimodal rather than normal. In this paper, a technique is developed to find these multimodal techniques using nonparametric density estimation. Its effectiveness is demonstrated by means of an example.

Oral contraceptives and breast cancer: review of the epidemiologic literature

Oral contraceptives have caused little or no overall increase in risk of breast cancer in women in developed countries, even in long-term users or after more than two decades since initial exposure. Limited evidence suggests a possible small increase in risk in users of oral contraceptives in developing countries, and further studies of breast cancer and oral contraceptives in low risk populations are warranted. Oral contraceptives may enhance risk of breast cancer in young women with a history of benign breast disease, and this possibility should also be investigated further. Multiple investigations have fairly consistently shown risk of breast cancer in women under age 45 years to be increased slightly in long-term users of oral contraceptives. Further studies should be conducted to elucidate the mechanism of this apparent phenomenon.

A study of 8 year neonatal deaths (1982-1989) of Toa Payoh Hospital

A study of 233 neonatal deaths out of 30910 livebirths over an 8 year period in the Toa Payoh Hospital is done. The Hospital has since ceased providing obstetric and neonatal intensive services from April 1990 due to restructuring of hospital care. The Neonatal Mortality Rates (NNMR) from 1982-1989 ranged from 6.52 to 9.55 and there was no significant fall in trend (p = 0.13). One hundred and thirteen (48.5%) neonates who died were below 1500gm (VLBW). Various causes of neonatal deaths were examined and there was a decline in respiratory distress syndrome (RDS) death rates (p less than 0.0002). Deaths due to asphyxia (p greater than 0.05) and infections (p greater than 0.05) have not declined significantly over the same period. It is also observed that less VLBW babies died over this 8 year period and the VLBW mortality rates (p less than 0.02) have declined. However, the congenital malformation mortality has also not declined significantly (p = 0.92) though early study (1972-1981) showed an increasing trend of malformation deaths among total neonatal deaths (p less than 0.02). Improvement in VLBW and RDS management has not contributed to a significant decline in NNMR. It is observed that more VLBW babies were born during this 8 year period (p = 0.01) especially so in the less than 1000 gm group (p = 0.0005) and the survival of VLBW babies has improved (45.5% to 75.8% alive) as a result of advances in neonatal intensive care. The reasons for increase in incidence of VLBW births in the past few years are not known.(ABSTRACT TRUNCATED AT 250 WORDS)